EDGE_TABLE
Monthly aggregation of provider referrals, both explicitly stated on the claim and inferred via patient pathways.
Provider Relationships Reveal Practice Patterns
🤝 Provider relationships are at the core of provider networks, however, the healthcare industry's ability to track and build metrics around the company providers keep is traditionally poor.
🔗 CareQuery® takes great care in defining metrics around provider relationships, what we call "edges."
⛓️ These edges carry nuanced patient journey sensitivities that empower the identification both intentional and unintentional practice patterns and patient movements - over time with incredible detail.
Table Description
feature | description | example |
|---|---|---|
year | Year in which the primary encounter occured | 2023 |
month | Month in which the primary encounter occured | 2 |
ref_npi | National Provider Identifier (NPI) of the referring provider | 1447546585 |
ref_name | Full name of the referring provider | kellen benes |
ref_specialty | Primary specialty of the referring provider | therapy - physical medicine |
npi | National Provider Identifier (NPI) of the referred provider | 1003221029 |
name | Full name of the referred provider | gabriel jefferson |
specialty | Primary specialty of the referred provider | physician assistant |
inferred | Binary indicator of whether the relationship total was inferred.
| 1 |
num_patients | Number of unique patients referred within the explicit or inferred context of the relationship. | 4 |
num_encounters | Number of unique encounters referred within the explicit or inferred context of the relationship. | 14 |
total_line_charges | Total line-item provider charges for procedures rendered submitted to insurers by the referred provider (NPI). | 834.18 |
total_claim_charges | Line-item provider and facility charge for procedures and revenue codes rendered and submitted to insurers. | 1,250.39 |
total_smart_allowed | Total smart allowed made by the referred provider within the inferred context of the relationship. Smart Allowed is the line-item estimate of allowed amount, utilizing proprietary ML on actual adjudicated amounts to provide estimates, within an average of 5% variance from actuals. | 902.06 |
Updated about 2 months ago